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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ] 0 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory AfFaits, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instruction directed a[ entry of that information already
<br />preprinted.
<br />2. Enter "Pernittee Name/Mai/rng Address (and facility name/location, if different);' " Permit NumF,er;' and "Discharge
<br />Nunrher" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monilorizrg Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measurement" data for each parameter under "Quan'ity"and ~araliry" as specified in permit. "Average" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sa,nple measurements for each parameter
<br />obtained during "Mcnit~.ring Period'; ",tlasim!!;:r" and i,li,ri,;runr" arc normally extcme high and low measurements
<br />obtained during '7vlonito;-rng Paric,!". (Note to murSc c's tvitlr secondar}~ treatment rttiuirement: Enter 30-day a~ era„e
<br />of sample measurements under "Avera~~,"and enter maximum 7-clay average of s~nplc meas~zrcments obtained d•;r'ng
<br />monitoring period under "Moxinrum.")
<br />G. Enter "Permit Re?vinmant" for cacri parameter w~d~r "~rarr[i!•~" ar_d "~rrality" as specified in permit.
<br />7. Urd~~ ';?r-= Ez" eater numbc- of sample mceser-ent during moniter:~~ :~riod the'. c cctl ma::imum (ancL'or mini. mom.
<br />or 7-day average as appropriate) permit rEauiremcr.' for each ; armatcr. If none, cnt_r "0".
<br />S. Enter "F,-rquozy of ~!r+alysis" both ~, "Su~:rrh- ,i/>>sr~ a,,:.: r'" (£ct!et fr,;qucncy of s:.mpling amd analysis used during
<br />monitorng period) and as "Pe;;:nt Re;;~r,-,:rrar~" spay; icd in ~~:..r.it. (e.g. %ntcr ".^. ,,,r,"for continuous monitoring, "//7"
<br />far one day per week, "1/30" for one day per moot'.r, "1/90" `crone day per quarter, etc.)
<br />S. Emtcr "SauvfL T,Fe" both as "S1;nple i:7~nrlo,r:'azrt" (cctual sample ty;,e used du~in~ monitoring period) and as "F,.•nait
<br />2quirazna,;t," (c.g. Enter "Grab" for imdividurt sample, ").,?!/C" for 2C~-hour camposite, i'.'/A" for continuous
<br />monitoring, etc.)
<br />t 0. ['/hare violations of perr:it t:quirements ere spored, at+tch a b,ief esp!anatia~ to describe cause and coaectwe action:
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occurs doting ,:.amptaring pe:icd, cn':r'T!o Cischzr6c" across faro in place ofdata entry.
<br />12. Enter Name/Titlr of Principal F.ce_ulire G~~~r" ~:ith "Sloua+are cJ Frim lr~! Er~_utivz G~~::z: cf AntSo,i:-~~
<br />Agent, ""Talaplr„re Number, "and "Gate" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pcrmi ~. Retain copy for your r,:cords.
<br />l4. Mo;-e detailed :ms5uctions for use of :his Disc; ~n-ge ,b:onito-r.rg R ;~~„t ('%rl.~ fo-•-i mry be obtained from Cxce(s;
<br />specified in petmit.
<br />r.
<br />This report is required by law (33 U.S.C. 1315; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result iii
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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